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Volume 328:1433-1437 May 20, 1993 Number 20 Next

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ABSTRACT

Background The results of case-control studies and anecdotal reports suggest that pancreatitis may be a risk factor for pancreatic cancer, but there have been no studies of sufficient size and power to assess the magnitude of the relation between these two diseases.

Methods and Results We undertook a multicenter historical cohort study of 2015 subjects with chronic pancreatitis who were recruited from clinical centers in six countries. A total of 56 cancers were identified among these patients during a mean (±SD) follow-up of 7.4 ±6.2 years. The expected number of cases of cancer calculated from country-specific incidence data and adjusted for age and sex was 2.13, yielding a standardized incidence ratio (the ratio of observed to expected cases) of 26.3 (95 percent confidence interval, 19.9 to 34.2). For subjects with a minimum of two or five years of follow-up, the respective standardized incidence ratios were 16.5 (95 percent confidence interval, 11.1 to 23.7) and 14.4 (95 percent confidence interval, 8.5 to 22.8). The cumulative risk of pancreatic cancer in subjects who were followed for at least 2 years increased steadily, and 10 and 20 years after the diagnosis of pancreatitis, it was 1.8 percent (95 percent confidence interval, 1.0 to 2.6 percent) and 4.0 percent (95 percent confidence interval, 2.0 to 5.9 percent), respectively.

Conclusions The risk of pancreatic cancer is significantly elevated in subjects with chronic pancreatitis and appears to be independent of sex, country, and type of pancreatitis.

Source Information

From the Departments of Surgery and Community and Preventive Medicine, New York Medical College, Valhalla (A.B.L.); the Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (P.M.); the Service of Gastroenterology and Digestive Endoscopy, University of Verona, Verona, Italy (G.C.); the Gastroenterology Service, Department of Medicine, University Hospital, Zurich, Switzerland (R.W.A.); the Departments of Internal Medicine, University of Gottingen, Gottingen, Germany, and the Municipal Hospital of Luneburg, Luneburg, Germany (P.G.L.); the Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Denmark (J.R.A.); the Gastrointestinal Research Unit and Section of Clinical Epidemiology, Mayo Clinic, Rochester, Minn. (E.P.D.); the Department of Surgery, Lund University, Lund, Sweden (A.A.-S.); and the Department of Surgery, Orebro Medical Center Hospital, Orebro, Sweden (L.D.). Presented as an abstract at the annual meeting of the American Pancreatic Association, November 5-6, 1992.In addition to the authors, the members of the International Pancreatitis Study Group included Vincenzo Di Francesco, M.D., Paolo Pederzoli, M.D., Annette Lohr-Happe, M.D., Einar Krag, M.D., L. Joseph Melton, III, M.D., Peter Boyle, Ph.D., C.S. Pitchumoni, M.D., M.P.H., and Pe Shein Wynn, M.D., M.P.H.

Address reprint requests to Dr. Lowenfels at the Department of Surgery, New York Medical College, Valhalla, NY 10595.

Full Text of this Article

Related Letters:

Pancreatitis and the Risk of Pancreatic Cancer
Ekbom A., McLaughlin J. K., Nyren O., Lowenfels A. B.
Extract | Full Text  
N Engl J Med 1993; 329:1502-1503, Nov 11, 1993. Correspondence

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